the dc mother-infant behavioral wellness program

Conditions: Perinatal Depression; Perinatal Anxiety; Prenatal Stress

Summary: this randomized controlled study will examine the effectiveness of patient navigation with culturally adapted cognitive-behavioral interventions and peer support groups for low-income black/of african descent pregnant women who are experiencing stress, anxiety, and/or depression.

the overarching objective is to develop and evaluate a collaborative, multi-dimensional and culturally tailored community-based model of integrated perinatal mh care. the target population is low-income black/of african descent women with pregnancy-related stress, anxiety, and depression. there are two specific aims: (1) to refine an individualized plan to integrate patient navigation and a culturally adapted cognitive-behavioral (cbt) intervention for low-income black/of african descent women designed to increase recruitment and retention within the healthcare community system, and (2) through a two-arm prospective randomized controlled design, women who are subthreshold and threshold risk for prenatal stress, depression and/or anxiety will participate in one of two interventions: (a) existing prenatal intervention (usual care); or (b) patient navigation plus culturally adapted cbt, and peer support groups. the investigators will screen 1,000 low-income pregnant aa women (18-45 years of age) in their second pregnancy visit with validated tools for stress, anxiety, and depression. a total of 700 study participants will be recruited from urban prenatal care centers in the washington dc area and will be randomized usual care of intervention conditions above (n=350/condition). following randomization, participants will participate in a diagnostic interview based on dsm-5 criteria to 'self-select' themselves into 1 of 2 groups (i.e., 'threshold' or 'subthreshold'). threshold includes women who meet criteria for depression or anxiety based on dsm-5 diagnostic criteria. subthreshold includes all other women who do not meet dsm criteria). in the intervention arm, participants in the threshold group will receive a 1:1 cbt treatment intervention, and participants in the subthreshold group will receive a group cbt intervention. both threshold groups will also include patient navigation and participation in a peer support group. participants will complete standardized health, mental health, and well-being questionnaires during pregnancy at their prenatal site, and up to 12 months after delivery at their well-baby visits, when they also will complete questionnaires about their infants' development and behavior. all infants also will undergo a standardized developmental test at 12 months. health care utilization and outcomes also will be collected through electronic medical records.

Eligibility criteria:
inclusion criteria: * black/of african descent * pregnant (gestational weeks ≤ 28 weeks) * age 18-45 * english proficient * receiving services in 1 of 4 study sites above * low-income: i.e., receiving medicaid * subthreshold or threshold risk for maternal distress (stress, depression, and/or anxiety) * able to provide consent exclusion criteria: * age \<18 * currently under the influence of a substance(s) * experiencing psychosis * critical (clinical) risk: actively suicidal or homicidal * not black/of african descent * planning to deliver outside dc

Keywords: postpartum depression postpartum anxiety pregnancy black women stress anxiety depression